[Hiring] Registered Nurse (RN) - Utilization Review @Dartmouth-Hitchcock Health

Role Description

Works with physicians and multidisciplinary team members to develop a plan of care for assigned patients. Ensures patient is progressing towards desired outcomes by monitoring care through assessments and/or patient records. Identifies and resolves barriers that hinder effective patient care. Actively involved in discharge planning process.

• Utilization Review specific experience preferred

Responsibilities

• Works with Medical Director and appropriate physician(s) to establish Dartmouth-Hitchcock (D-H) ambulatory and inpatient procedure list, updates and maintains list.
• Reviews reservation forms and the log of emergent and urgent admissions daily.
• Identifies areas that require intervention and education around the use of definitions.
• Reviews “one day stays” to assess appropriate use of level of care (LOC) determinations.
• Works with individual physicians and office staff when they are experiencing discrepancies with pre-certifications.
• Assumes responsibility for the oversight of inpatient denials, including, but not limited to, reviewing denial letters, collaborating with the Medical Director and appropriate physicians to determine the decision to appeal or accept, assisting in the response to Health Plan, etc.
• Develops and implements communication strategies to keep clinicians and staff informed of changes and current practice.
• Works closely with others to transition level of care determinations.
• Provides information to departmental leadership that reflects trends and practices that may need organization, intervention, and change.
• Collaborates with Health Plans to understand their definitions, articulates the definitions of D-H, and assists in the development of strategies for resolution of differences.
• Benchmarks with other facilities concerning admission and denial experience and policies.
• Performs other duties as required or assigned.

Qualifications

• Graduate from an accredited Nursing Program required.
• Bachelor of Science Degree in Nursing (BSN) with 3 years of experience.
• Masters of Science Degree in Nursing (MSN) preferred.
• Strong leadership, communication and computer skills desired.

Requirements

• Licensed Registered nurse with NH eligibility.

Benefits

• Loan repayment up to $20,000.
• Relocation Assistance and a Housing Coordinator to take on the burden of finding a home.
• Generous tuition reimbursement.
• Very popular "earned time" plan.
• Extensive CEU/Training programs.
• State-of-the-art 8,000 ft Patient Safety and Training Simulation Center.
• Central figures in the success of our system through our shared governance nursing model.
• Rigorous, research-focused environment.
• Accredited provider of continuing nursing education by the American Nurses Credentialing Center.